The 77th session of the World Health Assembly (WHA) just concluded at the World Health Organisation’s (WHO) headquarters in Geneva, Switzerland. It originally intended to adopt a new pandemic treaty and amendments to the 2005 International Health Regulations (IHR) that would tie country responses to the decisions of the WHO’s Director-General. In the end, it kicked one can down the road for a year, and partly filled another. The mandate of the Intergovernmental Negotiating Body (INB) was extended to continue negotiation on the wording of the new treaty (‘Pandemic Agreement’), and the Assembly adopted a limited package of binding and non-binding amendments to the IHR. This outcome, reached during the very last hours, is disappointing from many viewpoints, yet was not unexpected.
Both texts were pushed in unusual haste by those who advised, supported and mandated catastrophic public health responses to COVID-19. Ignoring Covid’s probable lab-based origins, the official narrative backing the measures remains that “the world is unprepared for the next pandemic”. Spending over $30 billion per year on surveillance and other measures aimed solely at natural outbreaks will somehow fix this.
The 77th WHA has sent a clear warning to the world that the global pandemic agenda is moving forward. WHO is in the driving seat, with States Parties’ consent to ignore procedural requirements to get the job done. The deplorable absence of serious questions at the WHA on i) the economic costs versus benefits of this agenda, ii) the potential impact of new amendments on human rights and iii) the scientific foundations of the systematic surveillance approach, signals that the drivers are political rather than evidence-based.
Those who seek to ensure that future pandemic preparation and response takes account of the recent lessons of the COVID-19 response, and adheres to the basic principles and ethics that underlie public health, have seen another predictable set-back. But overcoming vested interests with truth is an age-old battle, and takes time and courage.
Outcomes of the drafting process
The INB was unable to come to sufficient consensus on a viable text to present to the WHA, despite continuing two months beyond its original deadline of March 2024. Hence, its mandate was extended for another year, with a rotation of the bureau’s members. A special WHA session may be convened for adoption if consensus will be reached sooner. Since much of the concern over the proportionality and appropriateness of the proposed Pandemic Agreement came from state delegations to the INB, the composition of its new bureau will be crucial to its outcome.
The process for presenting the IHR amendments was remarkable, given that they are intended to be legally-binding on member states. Despite the WGIHR failing to produce a text fit for a vote until hours before the consensus text was presented to the WHA, rather than four months prior as legally required by Article 55 (2) of the IHR, it was still tabled for approval.
The negotiations even continued in parallel with the WHA session, until a final consensus text was reached. France, Indonesia, Kenya, New Zealand, Saudi Arabia and the U.S. authored the resolution adopting the amendments, plus Canada as a co-sponsor. On the public webcast (Plenary, 1 June 2024, 20:55-22:50), the WHA Chair chose not to call for a formal vote by show of hands after the text was read aloud. A total of 45 speakers, representing countries and regional groups and totaling 109 States Parties, expressed their commitment to this multilateral approach. Ethiopia spoke on behalf of 48 African countries, Mexico for 16 American countries, and the European Union for its 27 Members. This therefore represents a clear majority of the 196 States Parties to the IHR. Much was said on the importance of learning from the COVID-19 pandemic by adopting the amendments and continuing the INB’s work, while ignoring the failure of scientifically unfounded Covid measures and their devastating consequences on economies, societal cohesion and non-Covid health burdens.
The WHO immediately called this outcome “historic” and a key step for countries to “build on lessons learned from several global health emergencies”. Upcoming official speeches from the WHO’s sister organisations in the United Nations system as well as from governments may well extoll it with similar rhetoric. It was nevertheless extremely disappointing for the public and numerous grassroots organisations who have manifested their opposition since the beginning of the process. While the WHA was deliberating, a rally and march of activists against the global pandemic agenda happened in front of the UN Office in Geneva.
It is rather unfortunate that only a very small number of countries (Argentina, Islamic Republic of Iran, Netherlands, Slovakia, Russia and U.K.) took the floor to affirm their sovereign right to examine each of the amendments at home in a rational manner, then accept or reject or make reservations as appropriate. These amendments ultimately impact health, economies and human rights, and treaty approval often is the Parliament’s prerogative. The legal requirement of the IHR is to ensure such reflection, and in ignoring this member states diminished their own citizenry.
Observations of the amendment process
Unprecedented mobilisation of the public has occurred locally and globally by groups and individuals concerned with the WHO’s pandemic preparedness agenda. This probably modified the direction of the IHR race car, through influence on politicians and maybe on delegates during the negotiations. For example, the proposal on making all WHO’s recommendations mandatory for countries was on the table until it was dropped in March 2024. Growing concerns over proportionality and risks have also struck a chord with those in the process, many of whom, in working for a good outcome, find themselves struggling with opaque or misrepresented claims by institutions backing the agenda.
WHO’s response to much of this has been to denigrate the public, applying terms such as ‘anti-vaxxer’ to people promoting orthodox public health process. This has undoubtedly undermined public trust. Politicians brave or concerned enough to speak out have tended to belong to opposition parties, or been relegated to them by those wielding power. However, the issues at stake – international rule of law, human rights and fundamental freedoms, especially the right to bodily autonomy and the necessity of informed consent – should not be political. With few exceptions, leaders in power have relentlessly affirmed their support for the WHO projects. The mainstream media, in turn, have been surprisingly quiet and prefer not to question the official narrative. Thus, despite the potential impact of the agenda, there may be little hope that a large number of countries will choose to exercise their right to reservation and rejection in the permissible 10 months (according to amendments to Articles 59 and 61 IHR, made in 2022 and just entered into force on May 31st 2024).
Overall, the process has seriously altered public perceptions and trust in the United Nations system in general, and in the WHO in particular. Supranational bodies, typically located in safe and rich cities, detached from people’s daily lives and conditions and increasingly allying themselves with the rich, discuss and make decisions on all sorts of questions that many of us barely hear about. As demonstrated in this case, they can be as lawless as they wish with little or no consequence. They are constantly seeking to make themselves relevant by producing more and more of what may be termed ‘soft laws’ – declarations, agendas, policy guidelines and strategies – which in turn may pave the way for mandatory rules to come. This is not what democracy is about, but what previous pro-democracy movements stood against.
Conclusion
Good policy takes time and requires honest and open discussion. In vilifying opposing views and misrepresenting risk, the WHO is not serving member states well as the secretariat and technical input to the WHA. This is reflected in the 77th WHA outcomes. If the WHO is to serve a useful and positive role in global health, populations must demand better of their governments, who in turn must require a return to evidence-based and proportionate public health policy.
In its concentration on pandemics above other priorities, the WHO appears to have forgotten that it was set up to serve the people, especially the poor and vulnerable. By recklessly pushing its agenda forward at the expense of other health issues, it has forgotten the most fundamental principle proclaimed in its 1946 Constitution: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”
Dr. Thi Thuy Van Dinh (LLM, PhD) worked on international law in the United Nations Office on Drugs and Crime and the Office of the High Commissioner for Human Rights. Subsequently, she managed multilateral organisation partnerships for Intellectual Ventures Global Good Fund and led environmental health technology development efforts for low-resource settings.
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